From the FDA Drug Label
C Drug–Laboratory Test Interactions The following laboratory results may be altered by the use of estrogen plus progestin therapy: Increased sulfobromophthalein retention and other hepatic function tests.
Yes, progesterone can cause an increase in Liver Function Tests (LFTs) when used in combination with estrogen therapy, as it may alter hepatic function tests 1.
From the Research
Progesterone is unlikely to cause a significant increase in liver function tests (LFTs) in most patients, and its effects on liver function are generally mild and transient. The most recent and highest quality study on this topic is from 2012 2, which investigated the mechanism of exacerbative effect of progesterone on drug-induced liver injury. However, this study focused on the exacerbating effect of progesterone in immune-mediated hepatotoxic responses, rather than its direct effect on liver function tests. Other studies have shown that progesterone can have a beneficial effect on liver function in certain conditions, such as primary biliary cirrhosis and chronic active hepatitis 3. Additionally, a study from 1993 found that micronized natural progesterone did not have any liver-related side effects in postmenopausal women 4. In terms of liver enzyme elevations, the most commonly affected enzymes include alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Some key points to consider when evaluating the effect of progesterone on liver function include:
- The mechanism behind progesterone's effect on liver function involves its influence on hepatic metabolism, as the liver is responsible for metabolizing steroid hormones.
- Progesterone can alter bile flow and composition, potentially leading to cholestatic changes that manifest as elevated LFTs.
- Patients with pre-existing liver conditions may be at higher risk for more significant elevations in LFTs.
- Regular monitoring of liver function is recommended when starting progesterone therapy, particularly in patients with known liver disease or those taking other medications that affect liver function.
- If significant elevations occur (typically more than 3 times the upper limit of normal), dose adjustment or discontinuation may be necessary.